Effects of Computerized Provider Order Entry and Nursing Documentation on Workflow
Article first published online: 10 SEP 2008
© 2008 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 15, Issue 10, pages 908–915, October 2008
How to Cite
Asaro, P. V. and Boxerman, S. B. (2008), Effects of Computerized Provider Order Entry and Nursing Documentation on Workflow. Academic Emergency Medicine, 15: 908–915. doi: 10.1111/j.1553-2712.2008.00235.x
- Issue published online: 1 OCT 2008
- Article first published online: 10 SEP 2008
- Received March 16, 2008; revisions received June 2 and July 17, 2008; accepted July 25, 2008.
- electronic medical records;
- computerized provider order entry;
- emergency medicine;
- medical services;
- patient care processes
Objectives: The objective was to measure the effects of the implementation of computerized provider order entry (CPOE) and electronic nursing documentation on provider workflow in the emergency department (ED).
Methods: The authors performed a before-and-after time-motion study of the activities of physicians and nurses. The percentages of time spent in task categories were calculated by provider session and averaged across provider sessions.
Results: There was a shift in physician time from working with paper alone, 13.1% to 9.6% (p = 0.05), to working with paper while using a computer, 1.6% to 4.3% (p = 0.02), and an increase in time spent working on computer and/or paper from 30.0% to 38.9% (p = 0.02). For nurses, the increase in time spent on computer from 9.5% to 25.7% (p < 0.01) was offset by a decrease in time spent working with paper from 16.5% to 1.8% (p < 0.01). Direct care decreased minimally for nurses from 56.9% to 55.3% (p = 0.69), but from 36.8% to 29.1% (p = 0.07) for physicians, approaching statistical significance. Care planning decreased for nurses from 9.4% to 6.4% (p = 0.04) and from 21.7% to 19.5% (p = 0.60) for physicians.
Conclusions: The net effects of an implementation on provider workflow depend not only on changes in tasks directly related to the provider–computer interface, but also on changes in underlying patient care processes and information flows. The authors observed an unanticipated shift in physician time from interacting with nurses and patients toward retrieving information from the electronic patient record. Implementers should carefully consider how implementations will affect information flow and then expect the unexpected.